title: Pretreatment C-reactive protein is a predictor for outcomes after reduced-intensity allogeneic hematopoietic cell transplantation.
abstract: We tested the independent prognostic impact of 2 commonly used biomarkers, C-reactive protein (CRP) and interleukin (IL)-6, on the outcomes of allogeneic hematopoietic cell transplantation (HCT). Consecutive patients who underwent a uniform reduced-intensity conditioning (RIC) regimen of fludarabine (Flu), melphalan (Mel), and alemtuzumab were evaluated retrospectively. Cryopreserved serum samples drawn before the RIC were available to measure CRP levels in 81 patients and IL-6 levels in 79 patients. Patients with CRP levels above the median of 18.5 mg/L had significantly more grade 3-4 hepatic toxicity (P=.01), longer HCT hospital stay (P=.005), more acute graft-versus-host disease (aGVHD) (P=.003), greater nonrelapse mortality (NRM) (P=.01), and inferior overall survival (OS; P=.02). Higher baseline CRP showed no significant correlation with grade 3-4 infectious toxicity (P=.09). In contrast to CRP, pre-HCT IL-6 levels above the median of 78.3 pg/mL did not confer a statistically significant increased risk of toxicity or mortality. An elevated HCT comorbidity index (HCT-CI) did not predict for any measure of HCT morbidity. After adjustment for disease status, comorbidity, performance status, and age, elevated CRP concentration remained predictive of NRM. These data require confirmation in non-T cell-depleted conditioning regimens. If validated, they suggest that preconditioning CRP holds promise for enhancing estimates of transplantation tolerance.
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago, The University of Chicago Cancer Research Center, Chicago, Illinois 60637, USA. aartz@medicine.bsd.uchicago.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.forename: Amittha
authors.initials: A
authors.lastname: Wickrema
authors.forename: Shira
authors.initials: S
authors.lastname: Dinner
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Godley
authors.forename: Masha
authors.initials: M
authors.lastname: Kocherginsky
authors.forename: Olatoyosi
authors.initials: O
authors.lastname: Odenike
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Rich
authors.forename: Wendy
authors.initials: W
authors.lastname: Stock
authors.forename: Jodie
authors.initials: J
authors.lastname: Ulaszek
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000401:mortality; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D008107:Liver Diseases / Q000097:blood / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D014408:Biomarkers, Tumor; C508600:IL6 protein, human; D015850:Interleukin-6; D019653:Myeloablative Agonists; D002097:C-Reactive Protein